Is 60 days of ciprofloxacin administration necessary for postexposure prophylaxis for Bacillus anthracis?

Antimicrob Agents Chemother. 2008 Nov;52(11):3973-9. doi: 10.1128/AAC.00453-08. Epub 2008 Aug 25.

Abstract

Sixty days of ciprofloxacin administration at 500 mg every 12 h is currently recommended for the prophylaxis of inhalational exposure to Bacillus anthracis. We examined Bacillus anthracis (Delta-Sterne strain) in our hollow-fiber infection model. We measured the ciprofloxacin concentrations achieved and the number of organisms present before heat shock (total population) and after heat shock (spore population). We fit a mathematical model to these data. Monte Carlo simulation with differing initial spore burdens (3, 5, and 6.9 log(10) CFU/ml) demonstrated that 35 days of this regimen would completely clear the spore burden in 95% of patients. Durations of 110 days did not achieve 99.9% eradication, irrespective of initial burden, because of between-patient variance in drug pharmacokinetics. Given the absence of person-to-person transmission for Bacillus anthracis, adverse drug effects with long-term ciprofloxacin administration, and the possibility of engendering resistance in bodily flora, shorter prophylaxis duration should be given consideration, along with careful monitoring of all exposed individuals.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Anthrax / microbiology
  • Anthrax / prevention & control*
  • Anthrax / transmission
  • Anti-Bacterial Agents / administration & dosage*
  • Bacillus anthracis / drug effects
  • Bacillus anthracis / genetics
  • Bacillus anthracis / isolation & purification
  • Ciprofloxacin / administration & dosage*
  • Colony Count, Microbial
  • Drug Administration Schedule
  • Drug Resistance, Bacterial / genetics
  • Heat-Shock Response
  • Humans
  • Models, Biological
  • Models, Statistical
  • Monte Carlo Method
  • Mutation
  • Spores, Bacterial / drug effects
  • Time Factors

Substances

  • Anti-Bacterial Agents
  • Ciprofloxacin